Individual provider Active NPI

Murray Brian Rudenberg, PH.D.

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1336368331
Registry record updated Oct 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 12844 Issued in CA
Practice address
2423 Camino del Rio S Ste 106
San Diego, CA 92108-3734
Phone
(858) 729-0692
Fax
(858) 638-1576
NPI assigned
Apr 25, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 12844 CA Primary

Addresses

Primary practice location

2423 Camino del Rio S Ste 106
San Diego, CA 92108-3734

Mailing address

2423 Camino del Rio S Ste 106
San Diego, CA 92108-3734
Phone (858) 509-7575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120917000041 CA Practitioner - Clinical Psychologist 4183872229 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern California Psychology Centers ApcGroup PAC ID 6406170653, 23 clinicians

Practice addresses (Care Compare)

8775 Aero Dr
Suite 238
San Diego, CA 92123-1756
Phone (619) 930-9524

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
12844CAMDProfessional Counselor
PSY 12844CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Psychology Centers, Apc CurrentSince Apr 1, 2020 Accepting new patients
Mihir Parikh, M.D. Inc Current Accepting new patients
Eye Institute of California Medical Group Inc PastSince May 28, 2020 Accepting new patients
Robert Zalewski-Zaragoza, MD, Inc Past Accepting new patients

Locations

8775 Aero Dr
San Diego, CA 92123
Phone (858) 565-4148

8775 Aero Dr
Ste 238
San Diego, CA 92123
Phone (619) 930-9524

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288310400000",
    "number": "1336368331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2423 CAMINO DEL RIO S STE 106",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083734",
            "telephone_number": "858-509-7575",
            "fax_number": "858-794-0370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2423 CAMINO DEL RIO S STE 106",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083734",
            "telephone_number": "858-729-0692",
            "fax_number": "858-638-1576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDENBERG",
        "first_name": "MURRAY",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2010-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 12844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.